Herbal Supplements, which ones work? Jim Painter PhD, RD Professor, Eastern Illinois University

Herbal Supplements,

which ones work?

Jim Painter PhD, RDProfessor, Eastern Illinois University

Herbal Supplements,

which ones work?

Jim Painter PhD, RDProfessor, Eastern Illinois University

Cavaliere, C., et al.(2008).Herbal Supplement Sales in United States

Top 10 Herbal Supplements By Sales

Supplement Sales

1 Soy $25,600,000

2 Cranberry $24,000,000

3 Garlic $20,500,000

4 Ginkgo $18,000,000

5 Saw Palmetto $17,000,000

6 Echinacea $14,400,00

7 Black Cohosh $8,600,000

8 Milk Thistle $8,600,000

9 Ginseng $8,400,000

19 St. John’s Wort $8,000,000

Basic Four Food Groups

Everything that is bad for you tastes good

Everything that is good for you tastes bad

Was good for you but not any more

If you eat that it you will kill you

Popular Herbal Supplements

I. GingerZingiber officinale

Ginger• Contains powerful

antioxidants– Gingerols, Shogaols,

zingerones

• Use - prevent or ease nausea

- Reduce motion sickness- Reduce morning

sickness- Reduce post surgery

nausea

N/V in Motion Sickness

N/V in Pregnancy

Study by Ozgoli, Goli & Simbar, 2009

Nausea Intensity

N/V Post-surgery

Percentage reporting POV

symptoms

0

10

20

30

40

50

60

70

80

Ginger Placebo

Study by Bone, et al., 1990.

II. Soy/ legumes

• Low in saturated fat

• Contains protein and other compounds that help lower blood cholesterol

Effect = reduced risk of heart disease

Effects: Meta-analysis of Soy protein on Serum Lipids

• 38 clinical studies; 730 people over 2

decades:

- 20 studies used soy protein isolate

- 15 used textured vegetable protein

• Lowering of serum cholesterol in 34/38

studies

• No effect in 4 studies

•In all studies, cholesterol averaged <185

mg./dl.

James W. Anderson, M.D., Bryan M. Johnstone, Ph.D., and Margaret E. Cook-Newell, M.S., R.D. N Engl J Med 1995; 333:276-282

Reduction of Total Cholesterol by Soy

0 20 40 60

127-198

201-255

259-332

>335

Init

ial C

hole

ste

rol

(mg

/dl)

Average Total Cholesterol Reduction (mg/dl)

05

1015202530

Red

ucti

on

in

Blo

od

C

hole

ste

rol m

g.

25 50 75

Soy Intake (grams)

Reduction of Blood Cholesterol

with Soy Consumption

Sources: Soy Protein

Soy Food Amount Soy Protein

Soy milk, plain 1 cup 8 g

Tofu ½ cup 10 g

Soy flour, defatted ¼ cup 8 g

Soybeans, cooked ½ cup 13 g

Roasted soynuts ¼ cup 12 g

Tempeh ½ cup 16 g

Source: United Soybean Board

III. Garlic

• Garlic has been used in traditional and folk medicine for over 4,000 years

• Garlic contains sulfur compounds • Eating one clove of garlic per day may

help decrease blood cholesterol levels

Effects: Garlic

• Prevents platelet “stickiness”• Inhibits constriction of arteries• Reduces LDL oxidation (leads to

clotting)• Prevents high blood pressure• Reduces blood lipids

Ackermann et al., 2001, Arch Intern Med, 161: 813-24.Butt et al., 2009, Crit Rev Food Sci Nutr, 49(6): 538-51

Component Responsible for Lipid Lowering

• Allicin, a sulfur compound• Volatile sulfur compounds are not present in intact cells• Release by:

– chopping– steaming– crushing

Garlic Compounds and the Effect on HMG-CoA Reductase

Liu & Yeh, 2002, J Nutr 132: 1129-1134

Recommendations: Garlic

• Experts still researching optimal dose• Conservative estimate = 1-3 cloves per

day

IV. Cinnamon

Cinnamon• Source of Manganese, iron,

calcium, and fiber– Cinnamaldehyde (Reduces stickiness

of platelets)– Cinnamyl acetate (Antioxidant)– Cinnamyl alcohol (Antioxidant)

Cinnamon – True Ceylon Cinnamon

• Arthritis – Reduces uric acid production

• Heart Health – reduce lipids/platelet adhesion

• Type 2 Diabetes – lower blood glucose

• Blood Pressure – Reduced blood pressure

Meta-analysis: Cinnamon & A1C

Allen, R. W., Schwartzman, E., Baker, W. L., Coleman, C. I., & Phung, O. J. (2013). Cinnamon Use in Type 2 Diabetes: An Updated Systematic Review and Meta-Analysis. Annals Of Family Medicine, 11(5), 452-459. doi:10.1370/afm.1517

V. Black CohoshActaea racemosa L.

Fast Facts• Main use: ease

menopausal symptoms like hot flashes or night sweats

• Most popular brand is Remifemin- it is a standardized extract– Commonly given in 20 mg

pills, twice a day

Effect of Black Cohosh on Menopausal Symptoms

Study by Vermes et al., 2005

Average Kupperman Menopausal Index (KMI)

Score

KMI score is out of 51 points and scores the following symptoms: hot flushes, paraesthesia, insomnia, nervousness, melancholia, vertigo, weakness, arthralgia or myalgia, headache, palpitations, and formication.

0

10

20

30

40

50

Week 0 Week 4 Week 8 Week12

Pilot Test of BC for hot flashes

Study by Pockaj et al., 2004.

Daily hot flash scores (mean of all participants)

0102030405060708090

100

Baseline Week 1 Week 2 Week 3 Week 4

Hot flash score is frequency of hot flashes X severity

Summary:

• Black cohosh is probably effective but may not work for everyone- try it for a few months to see if it works for you!

VI. Turmeric:• Long used as a yellow food coloring

and spice.• A principal ingredient in curry

powder(28%).• Contains three major curcuminoids,

which are responsible for the yellow color of the herb.

• Curcumin (diferuloylmethane) is the most significant curcuminoid.

Effect of Turmeric on lung cancer in MicePercentage that developed cancer

0 20 40 60 80 100

Placebo

Taxol

Curcumin

Curcumin& Taxol

MD Anderson Study

VII. Saw Palmetto

Main use: relief from urinary symptoms associated with

BPH

BPH Prevalence in Males

Does it work?- Peak Urinary Flow Rate

Pea

k U

rin

ary

Flo

w R

ate

(mL

/min

)

11

11.2

11.4

11.6

11.8

12

12.2

12.4

Month 3 Month 6 Month 9 Month 12

Saw Palmetto

Placebo

Study by Bent et al., 2006.

SP effect on DHT

Pg/g

0

1000

2000

3000

4000

5000

6000

Untreated Permixon

Testosterone

DHT (dihydrostes tosterone)

Study by Di Silverio, et al., 1998.

Maximal Urinary Flow Rate

Maximal Urinary Flow

Rate

(mL/sec)

VIII. Kava KavaPiper Methysticum

Witte, D. Loew, D. & Gaus, W. (2005). Meta-analysis of the efficacy of the acetonic kava-kava extract WS 1490 in patients with non-psychotic anxiety disorders. Phytotherapy Research. 19, p. 183-188.

Drug Interactions-Effective Uses

• Sedative• Anxiolytic• Muscle Relaxant• Mood stabilization• Reduce mild nervous anxiety• Restlessness & Agitation• Tension & Stress• Mild anti-inflammatory actions

Dosage

• Oral Use• Supplied by:

– Capsules: 100 -500mg

– Liquid: 1:1, 1:2– Tea

• Daily Dosage:– Capsules: Root extract:

150mg-300mg twice daily, with a daily dosage of Kava pyrones 50mg-240mg.

– Tincture: Taken as 30 drops with water 3 times daily

– Infusion: Take ½ cup twice daily

Results

Geier [3]

Kinzler [4]

Lehrl [5]

Malsch [7]

Volz [11]

Warnecke [12]

-15 -10 -5 0 5 10 15 20 25 30

Study by Witte, D. Loew, D. & Gaus, W. (2005).

HAMA Difference

Results

Younger

Older

Male

Female

All

0 -10 -5 0 5 10 15 20 25 30

Study by Witte, D. Loew, D. & Gaus, W. (2005).

HAMA Difference

IX. Valerian RootValeriana Officinalis

Dosage

• Daily dosage: 100mg-1800mg• Total internal daily dose: 15g root

powder, for restlessness 220mg three times daily, & for sleep aid 400mg-900mg of extract

YEAR NUMBER OF PARTICIPANT

DOSE DURATION SLEEP QUALITY INPROVEMENT

LEATHWOOD 1997 128 400 mg qhs 1 Day YES

BALDERER 1985 10 450 mg qhs 1 Day NO

LEATHWOOD 1985 8 450 mg qhs 1 Day NO

DIAPER 2004 16 300 mg qhs 1 Day NO

FARAG 2003 25 320 mg 4 Days NR

SCHULTZ 1994 14 405 mg tid 8 Days NO

KAMM-KOHL 1984 80 90 mg tid 14 days YES

KUHLMANN 1999 91 600 mg qhs 14 Days NO

DONATH 2000 16 600 mg qhs 14 Days NO

FRANCIS 2002 5 20 mg/kg 14 Days NO

DELSIGNORE 1992 51 100 mg tid 21 Days NR

COXETER 2003 21 225 mg qhs 21 Days NO

JACOBS 2005 270 600 mg qhs 28 Days NO

VORBACH 1996 121 600 mg qhs 28 Days YES

CERNY 1999 98 360 mg qhs 30 Days YES

JASEN 1977 150 100 mg tid 30 Day YES

Dichotomous Outcomes for Sleep Quality (Sleep improved or not)

0.1 1.0 10.0 100.0

Jacobs

Kamm-Kohl

Cerny

Vorbach

Leathwood (1982)

Jansen

Study by Bent. S. et. Al. (2006).

Relative Risk

X. St John’s Wort

Hypericum Perforatum

Quick Facts • Main Use: treatment for

mild to moderate depression,

• Extract is standardized to

0.3% hypericin; 300-600mg 3x/day

• Treatment of depression requires 2-6 weeks of treatment, and for full therapeutic dose use up to 6months

SJW & Mild to Moderate Depression

Kasper,S. et al, 2006

SJW vs. Standardized Depression Medication

Phillip,M. et al, 1999

To

tal S

core

HA

M-D

(m

ean

)

XI. Ginkgo Biloba

What is Ginkgo biloba?• Dietary Supplement• Composition

– Extract, flavonoid glycosides (composition?), terpene lactones and ginkgolic acid

– Main Uses: Improves cognitive function, anti-inflammatory effects, and vascular effects

Speed of Attention (total Msec)

TimeKennedy, DO, Scholey, AB, Wesnes, KA. Psychopharmacology. 2000

Kennedy, DO, Scholey, AB, Wesnes, KA. Physiol Behav. 2002. Based on Bond-Lader Visual Analog Scales.

Summary of effectiveness of Ginkgo and Ginkgo/Ginseng combination on cognition

• Enhanced speed of attention at 240 and 360 mg but not at 120 mg

• Quality of memory was enhanced at 120 mg and 240 mg of Ginkgo

• Working memory was enhanced with Ginkgo/Ginseng combo vs. Ginkgo alone

XII. Glucosamine & XII. Glucosamine & ChondroitinChondroitin

• Meta-analysis found that supplements used together narrowed joint space.

• Improved pain and mobility• More than 500 studies were

evaluated• 1,775 patients

Richy, F., & Bruyere O., 200355

• Largest clinical trial: Glucosamine/chondroitin Arthritis Intervention Trial (GAIT)

• GAIT has produced two sets of negative results.

• Glucosamine and chondroitin, alone or together, did not reduce osteoarthritis knee pain more than a placebo.

56

• Glucosamine & chondroitin may reverse osteoarthritis and decrease inflammation

• Both may relieve arthritis pain and stiffness with fewer side effects than conventional drugs.

• Although positive reports outnumbered negative ones, the negative ones have been larger and better designed.

57

• Do not use with: – Warfarin – Asthma – Allergic reactions– Constipation– Ulcers– Liver disease – Inflammatory bowl

disease

58

• Only for use with moderate-to-severe arthritis

• Give supplement three months to work

• Buy from researched supplier

XIII. Chocolate

• Cocoa processed with alkali is not beneficial

• High fat chocolate is not beneficial• High sugar chocolate is not beneficial• Cocoa is beneficial

Effects: CocoaComparison of Antioxidant Content

• Black tea (2gm bag) 1000 C for 2 min.• Green tea (2gm bag) 1000 C for 2 min.• Wine 140 ml. California Merlot.• 2 tbs. commercial Cocoa pwd. 200 ml

H20

Gallic acid equivalents (GAE), phenolicEpicatechin equivalents (ECE), flavonoidLee et al. (2003). Cocoa Has More Phenolic Phytochemicals and Higher Antioxidant Capacity the Teas and Red Wine.Journal of Agriculture and Food Chemistry, 51, 7292-7295.

Total Flavonoid and Phenolic Content of Tea, Wine and Cocoa

(per serving)

0100200300400500600700

Black Tea Green Tea Wine cocoa

mgGAEECE

Cocoa Inhibits Blood flow and Vessel Dilation

• Subjects 20 individuals at risk of CHD• Consumed a cocoa drink• 2 groups high and low flavanol• Brachial artery flow and dilation were

measured

Sies, et al. 2005. Cocoa Polyphenols and Inflammatory Mediators. American Journal of Clinical Nutrition, 81, 304s-12s.

Vaso-dilation with Cocoa Flavanols

0

1

2

3

4

5

6

7

Low flavanolcocoa

High flavanolcocoa

% FMDBefore2 hr After

FMD (Flow-mediated Dilation)Sies, et al. 2005. Cocoa Polyphenols and Inflammatory Mediators. American Journal of Clinical Nutrition, 81, 304s-12s.

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